Distal radius a ɛpaapae no ka akisikuru a ɛtaa ba wɔ nkwakoraa ne mmerewa mu no ho. Mprempren wɔkyerɛ nnipa a wɔadi fi mfe 50 kosi 75 ase sɛ wɔn a wɔn mfe akɔ anim. Distal radius a ɛpaapae a ɛba no kɔ soro afe biara bere a mpanyimfo a wɔn mfe akɔ anim a wɔde wɔn ho hyɛ mu no kɔ soro no. Asɛm a emu yɛ hyew wɔ akyinnyegye a ɛfa distal radius fractures ho no da so ara wɔ hɔ: So oprehyɛn ho hia?
Nyarewa Ho Nhwehwɛmu
Distal radius a ɛpaapae no yɛ bɛyɛ 18% wɔ nipadua a ɛpaapae nyinaa mu wɔ mpanyimfo a wɔn mfe akɔ anim mu. Caucasianfo dodow, ayarefo a wɔyɛ mmea, ne nnompe mu yare yɛ asiane atitiriw a ɛma obi mu paapae wɔ akyirikyiri. Nea ɛka ho no, ɛka mmere mu nneɛma nso ho, te sɛ nkwakoraa ne mmerewa a wɔhwe ase a wɔtaa bubu wɔ akyirikyiri kwan no so wɔ awɔw bere mu. Nhwehwɛmu ahorow bi abɔ amanneɛ sɛ ayarefo a wɔn mfe akɔ anim a wɔn adwene tumi ne wɔn ntini mu ntini nhyehyɛe a enni dɛm no wɔ asiane kɛse mu sɛ wɔbɛpaapae wɔ akyirikyiri (esiane sɛ ayarefo no wɔ nkate a emu yɛ den nti, wɔde adwene bɛtrɛw wɔn nsa mu de agyina fam bere a wɔahwe ase no, na ɛde akisikuru aba). .
Sɛnea akontaabu kyerɛ no, wɔ United States no, ayaresa ho ka a wɔbɔe wɔ distal radius fractures ho wɔ afe 2007 mu no bɛyɛ U.S. dɔla ɔpepem 170 (bɛyɛ U.S. dɔla 1983 / onipa). Ɛwom sɛ wɔsa ayarefo a wɔn mfe akɔ anim dodow no ara a wɔn distal radius fractures no yare wɔ ɔkwan a ɛnyɛ nea wɔahyɛ da ayɛ so de, nanso ayarefo dodow a wɔpaw sɛ wɔbɛyɛ oprehyɛn a wɔde besi wɔn mu no rekɔ soro afe biara. Ayaresa ho ka a wɔbɔ wɔ oprehyɛn mu nneɛma a wɔde si hɔ ho no yɛ nea wɔde sa yare a wɔmfa nnuru nni dwuma wom no mmɔho abiɛsa, na ɛma ayaresabea tra ne ɛka afoforo a ɛfa ho nso kɔ soro.
Nsonsonoe nso wɔ ɔmantam ne mmusuakuw mu wɔ sɛnea wɔde nneɛma a wɔde hyɛ nipadua no mu di dwuma ma distal radius fractures no mu. Nhwehwɛmu bi a wɔyɛe wɔ Medicare so kyerɛe sɛ mmea ne Caucasianfo taa yɛ oprehyɛn, na dodow a wɔpaw sɛ wɔde besisi wɔn mu no yɛ 4.6% kosi 42.1%. Na wohui sɛ nnuruyɛfo a wɔatete wɔn wɔ nsa oprehyɛn mu no taa paw oprehyɛn.
Ayaresa mu Nhwehwɛmu
Ɛsɛ sɛ wɔhyɛ ɔyarefo no opira kwan ne nwiinwii atitiriw no nsow wɔ ayaresabea abakɔsɛm mu, a baabi a ɛyaw no wɔ, dwumadi a ɔyɛ, ne sɛnea wadi dɛm kodu ka ho. Bere koro no ara mu no, ɛho hia nso sɛ wɔte ɔyarefo no nsa a ɛhyɛ ne so, nneɛma a wɔtaa de gye wɔn ani, ne adwuma a ɔyarefo no yɛ no ase. Nea ɛka ho no, ɛho hia kɛse sɛ wuhu sɛ ebia ɔyarefo no wɔ nnompe mu yare anaasɛ nea efi mu ba a ɛka ɔhonam akwaa a ayɛ no dwumadi ansa na wapira no. Wɔn mu bi ne sɛ, sɛ wobebisa ayarefo a wɔn mfe akɔ anim sɛ ebia ɛsɛ sɛ wɔde poma di dwuma bere a wɔnantew ne sɛ ebia wobetumi ahwɛ wɔn ho wɔ da biara da asetra mu no ho hia yiye na ama wɔate ayarefo ahiade ase na wɔayɛ nhyehyɛe a wɔde hwehwɛ yare no ne ayaresa.
Wɔ nipadua mu nhwehwɛmu a wɔyɛ wɔ ayaresabea no mu no, ɛho hia sɛ wɔyɛ ɔyarefo no nsateaa mu nhwehwɛmu a wɔayɛ no nhyehyɛe na ɛkɔ akyiri fi akyirikyiri kosi baabi a ɛbɛn. Wɔnam capillary refill test ne radial ne ulnar pulse so na ɛkyerɛ mogya a ɛwɔ nsateaa no mu. Wɔnam nsɛntitiriw abien nyiyim sɔhwɛ ne hann a wɔde ka ho sɔhwɛ so nyaa nkate tebea horow a ɛwɔ mfinimfini ntini, ulnar ntini ne radial ntini no mu. Acute carpal tunnel syndrome a ɛba wɔ distal radius fractures mu no yɛ 5.4% kosi 8.6%, enti ɛsɛ sɛ wɔde adwene titiriw si paresthesia ne numbness wɔ median nerve no kyekyɛ beae no so. Wɔhwɛɛ ɔyarefo no ntini dwumadi denam nnompe ntam ntini a ɛwɔ anim ne akyi, ntini a ɛwɔ akyi, mfinimfini, ne ulnar ntini a wɔhwehwɛɛ mu no so. Bio nso, ɛsɛ sɛ nea ɔreyɛ nhwehwɛmu no nso hwɛ ɔyarefo no honam ani kuru no tebea so (te sɛ ecchymosis, edema, anim a ɛte sɛ kyɛnsee, ne nea ɛkeka ho) na ama wahu sɛ ebia ɛyɛ abubuw a abue anaa. Esiane sɛ ntini a ɛyɛ mmerɛw tebea nyɛ papa ne honam ani hwɛbea a ɛyɛ tratraa wɔ nkwakoraa ne mmerewa mu nti, mpɛn pii no, honam ani mpaapae ka ho wɔ akyirikyiri radius a ɛpaapae ho. Sɛ wɔde closed traction reduction di dwuma a, ɛho hia titiriw sɛ wɔde ahwɛyiye yɛ adwuma na wɔakwati sɛ ntini a ɛyɛ mmerɛw foforo bɛsɛe.
Mfoninitwa Nhwehwɛmu
Mpɛn pii no, nea ɛka radiographic nhwehwɛmu a wɔyɛ wɔ distal radius fractures ho no yɛ anteroposterior, lateral, ne oblique radiographs. Wobetumi ate sɛnea abubuw no anim ne sɛnea ɛkyinkyini no ase denam mfonini mu nhwehwɛmu so de ahu sɛ ebia abubuw no asinasin no ayɛ tiaa, sɛ ebia wɔabubu abubuw no asinasin no, ne sɛ ebia nkwaa no mu nhama no awie anaa. Mfonini pɔtee afoforo a wɔde yɛɛ mfonini no bi ne: ulnar declination (kyerɛ sɛ 22°, range: 19°-29°), distal radius no sorokɔ (11-12 mm), ne palmar inclination a ɛwɔ akyirikyiri radius (ɛkyerɛ sɛ 11°, range: 11 °-14.5°). Wɔyɛ abasa ne nsateaa ho X-ray nso de hwɛ sɛ nsateaa asɛe anaasɛ nsateaa no ntumi nnyina. Wɔ closed reduction ne splint immobilization akyi no, ɛho hia sɛ X-ray film foforo de hwɛ sɛ ebia distal radius no parameters atu mpɔn anaa. Wɔ ayaresabea no, wɔtaa de CT nhwehwɛmu di dwuma de boa ma wohu na wɔkyekyɛ akisikuru mu (sɛ nhwɛso no, sɛ ebia akisikuru bi wɔ ntini no mu, sɛ ebia akisikuru bi wɔ hɔ a wɔde mia anaasɛ wɔatwitwa), sɛnea ɛbɛyɛ a wobehu oprehyɛn ayaresa nhyehyɛe no bio. Bere koro no ara mu no, ɛho hia nso sɛ wɔyɛ CT nhwehwɛmu na ama wɔatumi asusuw ho bio bere a wɔreyɛ nnompe a wɔatwitwa ne nnompe mu ayaresa a wɔde sa yare a ɛnyɛ den no.
Saa ara
Sɛnea AAOS ayaresa akwankyerɛ ahorow kyerɛ no, adwene biako nni hɔ wɔ sɛnea wɔde distal radius fractures ho dwuma a wɔde di dwuma wɔ ɔkwan a ɛyɛ katee anaasɛ oprehyɛn so bedi dwuma no ho. Wɔn adwene nhyia wɔ sɛ ebia wɔde volar locking plate fixation anaasɛ percutaneous Kirschner wire fixation bedi dwuma wɔ oprehyɛn ayaresa mu. Kodama ne ne mfɛfo kamfo kyerɛ sɛ wɔmfa nhyehyɛe a wɔde kyerɛ sɛnea ɔyarefo bi abubu no nni dwuma mfa nhu sɛ ebia ɛsɛ sɛ wɔyɛ ɔyarefo bi oprehyɛn anaa. Na wɔ ayarefo a wɔn mfe akɔ anim a wɔadi mfe ≥50 fam no, ɛsɛ sɛ wɔde sɛnea abubu no, nsakrae a ɛba wɔ radiographic parameters a ɛwɔ nsateaa nkwaa no mu, mfe a wɔadi, nsa a edi tumi, ne adwuma a ɔyarefo no yɛ no di dwuma de kyerɛ ayaresa nhyehyɛe no kɔ akyiri. Wɔ multiple regression analysis mu no, dodow a volar anaa dorsal distal radius fragment no sɛee bere a wɔatew so akyi, sɛ́ ebia abubu no fa ulnar kɔn ho, nsateaa a ɛkɔ fam, ne nsakrae a ɛba distal ulna no mu no ne nea efi ayaresabea mu ba no wɔ abusuabɔ kɛse.
Ayaresa a Wɔde Di Dwuma a Wɔkora So
Wɔ yɛn mfinimfini no, wɔtaa de Sugar tong plaster splint a ɛwɔ nsateaa no so siw distal radius fractures a entumi nkɔ baabi foforo kakraa bi no mu na ama wɔatumi asiw abɔso no a wɔbɛkotow ne nea ɛbɛkɔ fam no ano (hwɛ Mfonini 1). Sɛ abubuw no a ɛkɔ baabi foforo no yɛ kɛse a, ɛsɛ sɛ wɔyɛ Sugar tong splint bere a wɔatoto so awie no. Hyɛ no nsow sɛ sɛ woreyɛ plaster splint immobilization a, ɛsɛ sɛ scope of immobilization no gyae wɔ nsateaa no awiei a ɛbɛn no, sɛnea ɛbɛyɛ a nsateaa no bɛkɔ so ayɛ mmerɛw na asiw ano. Elastic bandages a wɔde di dwuma ma limited compression fixation betumi aboa ma splinting. Mpaapaemu ko a ɛbɛkyerɛ ɔkwan a wɔbɛfa so atew so a wɔatoto mu. Sɛ ɛho hia a, wobetumi apaw local hematoma anesthesia a ɛwɔ distal radius no, na afei wɔayɛ traction reduction denam nsateaa (index ne mfinimfini nsateaa) a wɔtwe so de siesie dɛmdi no na wɔsan de radiocarpal nkwaa no hyia. Wɔtaa de inverse fracture mechanism na ɛyɛ traction reduction. Traction reduction wɔ planes ahorow mu ho hia na ama wɔawie ligament sanba na wɔasan de alignment a fracture fragments, capitulum ne lunate. Wɔ coronal plane no so no, san fa ulna ne radius, distal bone fragment ne radial shaft no anatomical alignment no ba. Colles akisikuru a ɛtaa ba no so tew no hwehwɛ sɛ ɔboafo no kura ɔyarefo no nsateaa kɛse wɔ ne nsa biako mu na ɔde ne nsa biako kura ɔyarefo no nsateaa 4 mu, na ɔde countertraction di dwuma de tetew akisikuru no asinasin no fi metaphysis a ɛwɔ radius no mu, kɔ so twetwe tenten, na afei ɔde ne nsateaa di dwuma. Flexion ne ulnar deviation na aboa ma abubu asinasin no so atew. Wɔ ayarefo a wɔn mfe akɔ anim a ntini a ɛyɛ mmerɛw a atwa wɔn ho ahyia no asɛe fam no, ɛho hia sɛ wɔde ahwɛyiye di dwuma bere a wɔretew so no na amma honam ani ntetew (wobetumi de kotoku adi dwuma bere a wɔretew so no). Bere a wɔsan de sii baabi foforo akyi no, wɔyɛɛ ntini mu ntini mu nhwehwɛmu.
![Distal radius a ɛpaapae]()
Mfonini 1. (A) Wɔde Sugar tong plaster splint maa ɔyarefo bi a ne distal radius fracture no antumi ankɔ baabiara wɔ ne nsateaa tebea a ɛnyɛ nea ɛfa biribiara ho kakra mu sɛnea ɛbɛyɛ a ɔrentu bio; (B) ne (C) anim ne akyi radiographs a ɛkyerɛ sɛ ɔyarefo no nsateaa a wɔde si hɔ no ye. Plaster ahama no ntrɛw nkɔ akyiri nsen metacarpal ti no sɛnea ɛbɛyɛ a nsateaa no betumi akɔ sɛnea ɛsɛ.
Oprehyɛn Ayaresa
Oprehyɛn ayaresa a wɔpaw ma ayarefo a wɔn mfe akɔ anim a wɔn distal radius fractures no bi ne: closed reduction ne external fixation, percutaneous Kirschner wire fixation, open reduction, volar/dorsal locking plate fixation, ne dorsal bridging plate fixation (hwɛ nea wɔakyerɛ wɔ Mfonini 2 mu).
![Palm a wɔde to mu mprɛte]()
Wɔde open reduction ne dorsal plate fixation foforo no di dwuma titiriw de sa intra-articular fractures. Ebetumi atew ntini no ani wɔ anisoadehu tẽẽ ase a ɛrenyi ntini a ɛwɔ nsateaa no fã a ɛyɛ volar no mfi hɔ, na ɛtew asiane a ɛwɔ hɔ sɛ akyiri yi radiocarpal nkwaa no ntumi nnyina no so. Sɛ volar lunate fracture ka ho a, ɛsɛ sɛ wɔma ɛnkɔ baabiara. Wɔ ayarefo a radial shaft fracture anaasɛ wɔapirapira pii fam no, wobetumi de traction plate a wɔde ahyɛ mu no adi dwuma de anya so tew denam ligament sanba so. Bere koro no ara mu no, traction plate no nso fata ma comminuted ne osteoporotic distal radius fractures a wɔtew so na wɔde si hɔ. Woyii prɛte no wɔ oprehyɛn no akyi adapɛn 12, na na wobetumi anya ayaresa mu nkɛntɛnso pa.
Volar locking plate betumi ama radial shortening ne volar tilt atu mpɔn, na nsɛnnennen a ɛba no sua. Sɛ wɔde toto akyi mprɛte no ho a, wobetumi ama ahoɔden a ɛwɔ ɔhonam akwaa a ɛka no no mu atu mpɔn kɛse wɔ oprehyɛn no akyi asram 6 mu, na wobetumi ama dwumadi ne ɛyaw no atu mpɔn. Nsɛnnennen te sɛ dorsal plate fixation a ɛsan tu ne extensor digitorum tendon no abufuw ba wɔ nsɛm no mu bɛyɛ 30% mu. Na fixation effect a volar plate no nya nso ye sen Kirschner wire anaa external fixator de no.
Sɛnea Wɔtɔ Nnompe a Wɔde Si Nnompe Mu ne Nnompe Ho Nnwinnade!
Ma CZMEDITECH , yɛwɔ nneɛma a edi mũ yiye a ɛyɛ nnompe oprehyɛn a wɔde hyɛ nipadua mu ne nnwinnade a ɛne no hyia, nneɛma no ka ho akyi berɛmo mu nneɛma a wɔde hyɛ nipadua mu, nnadewa a ɛwɔ medullary mu, trauma mprɛte, mprɛte a wɔde to mu, cranial-maxillofacial a ɛwɔ anim, afiri a wɔde yɛ nipadua no, nnwinnade a wɔde anyinam ahoɔden yɛ, abɔnten so fixators, ntini mu nhwehwɛmu, mmoa ho ayaresa ne nnwinnade a wɔde boa wɔn.
Bio nso, yɛasi yɛn bo sɛ yɛbɛkɔ so ayɛ nneɛma foforo na yɛatrɛw nneɛma ahorow mu, sɛnea ɛbɛyɛ a yebedi nnuruyɛfo ne ayarefo pii oprehyɛn ahiade ho dwuma, na yɛama yɛn adwumakuw no nso asi akan kɛse wɔ wiase nyinaa nnompe a wɔde hyɛ nipadua mu ne nnwinnade adwuma no nyinaa mu.
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